The great Greek physician and teacher Hippocrates (460 BC-370 BC) described several kinds of cancer, referring to them with the Greek word "carcinos", meaning crab or crayfish. This name comes from the appearance of the cut surface of a solid malignant tumor, with the "veins stretched out on all sides as the animal the crab has its feet, whence it derives its name."

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Tag Archives: Terminal Illness

Have I given fire and rifted Jove’s stout oak
With his own bolt; the strong-based promontory
Have I made shake and by the spurs pluck’d up
The pine and cedar: graves at my command
Have waked their sleepers, oped, and let ‘em forth
By my so potent art. But this rough magic
I here abjure

Prospero, The Tempest, Wm. Shakespeare

Two weeks ago today, we lost our big male deerhound Magic. It should not have been any surprise—he had been diagnosed with cardiomyopathy in August and from the looks of his echocardiogram August 8th, his days were numbered. He was with us for over ten years, a long life for a giant hound. But the finality of death is always a surprise, isn’t it?

Can dogs perceive tragedy in their lives? Do they grieve as we do? If so, Magic had grief aplenty. Acquired as a four month old puppy with his half-sister Angelina, he was fine until at six months, he fractured a metatarsal bone taking a corner too fast, and after surgery to pin the shattered bone he spent six weeks in a cast. He recovered just fine, well enough to finish his championship at 18 months without a trace of a limp to suggest his prior injury. From the time he was a puppy, we called him The Dog Who Never Did Anything Wrong. He never got sick, never barked, never growled, and never EVER had an accident in the house. Following the example of our older male Izzy, he was a friend to all—humans, dogs and cats. Well maybe once he chased a horse, but after the embarrassment of being chastised, he never did it again. He was a homebody, afraid of fireworks and thunder and lightning, but as long as he had his family about him, he bore no complaint. When his sister and constant companion Angelina passed, he clearly had a period of sadness, but bounced back quickly. But when we lost Izzy and in rapid succession the little dog Jack to old age, Magic lay down on the carpet in the family room between the coffee table and the chairs, head between forelegs, and there he stayed. He ate his meals, and went out twice a day to do his business (“whether he needed to or not!” we joked). But the exuberance and sense of humor that characterizes the deerhound personality was gone.

When we sold our home in San Diego in October, and decided to move to New Mexico, Magic was the dog we worried about the most. Given his heart condition, we weren’t sure that he could make the transition to altitude and cold weather. We worried and fretted and even considered putting him to sleep, but in the end, since he wasn’t in any pain, we loaded him, the two girl deerhounds and the little rescue Yoda into the van and off we went. Our biggest fear was that we would have to find a veterinarian somewhere along Interstate 40 to do what we hadn’t been able to bring ourselves to do before we left. But the big dog surprised us. Here in Santa Fe, he seemed to take a new lease on life. Suddenly he was interested in his surroundings—he ran, he played, and he discovered where the bunnies were hiding in the culvert. He patrolled the fence line at sunset, watching for coyotes. He assumed the role of pack leader for the first time in his life. His two female consorts adored him, and he was The Man. And, like a family member of any patient diagnosed with a terminal illness, I began to have magical thinking: first, let’s see if he makes his tenth birthday! He did. Then, let’s see if he makes Thanksgiving, when the kids come home! He did. And then, jeepers, maybe he’ll see Christmas, and even another New Years! He did. So then I began thinking about his eleventh birthday, next October. As I said, death is always a surprise.

As we get older, each loss hits harder. I’ve done a lot of thinking about this these last two weeks. When we are children, the family dog seems to live forever. He’s there when we start kindergarten, then junior high, then high school. He comforts us when we’re sad. Our lives, and his life, while not equivalent, are at least proportionate. But as we age, the lifespans of our pets seem to shrink. Now that I am 61, Magic’s life seems to mine a mere blink of the eye. He was there, beside my bed, every night for ten years. And now he is gone, and I’ll never again curse under my breath as I trip over him in the dark, and my life is much the worse for that.

The sudden illness of a colleague is always a shocking surprise. As physicians, we are trained from an early age to ignore our own infirmities in the service of others. Apart from my three C-sections, I have been extremely fortunate in terms of my own health—I can count the number of sick days I’ve taken in the last thirty years on one hand and I am thankful every day for that blessing. In my day to day world of caring for cancer patients, I know that in an instant, by accident or by sickness, everything can change. I think that my colleague must have felt the same—that calling, that mission to care for the stricken that leads one to suppress the rising signs of illness in order to keep that black curtain of infirmity a little further to the edge of the window frame of life.

On Monday I learned that the man I have grown to respect for his insight, his dedication to his profession and his kindness would likely not be coming back to work, ever. My entire department was devastated, especially his nurse who has worked so closely with him for the eighteen months he has been with us, and also his patients, each of them with cancer, who asked me one by one when they saw me for their weekly on treatment visit, “I am so sorry to hear that he is ill. When is he coming back?” As the realization of the gravity of his illness slowly came to all of us, since he had not shared the knowledge of his disease with any of us, the weight began to descend. Our patient load is at its highest, our working hours are extended, there are patients waiting to be seen, planned and treated. Who will step in to consult on these patients, to plan their radiation treatments, to oversee their side effects and work the extended hours? Right now, we do not know.

I have always said that unlike my father, I do not want to “die with my boots on.” I want to retire while I am still healthy enough to do the things that I’ve put off for so many years—to write, to paint, to take photographs, to teach English, to travel, to play with my dogs, and perhaps, just perhaps, get another horse—an older horse, a calm horse (we grow so brittle as we age that we break more easily!) who will carry me down the trails so that I can smell the orange and lemon blossoms on the trees, up close, as they bloom in late December here. I said this to my husband last night, at the end of a very long week. He said, “No one ever knows what they will do when faced with a terminal illness.”

This was a very busy week in the clinic, and I had a medical student rotating with me. In the chaos that surrounded us, I had to keep reminding myself, first things first. Yesterday, together we saw a man with a life threatening cancer. I was running very late, and he was the last new patient of the week. My student took the reins—he interviewed the patient, examined the patient, explained the treatment and seamlessly introduced me to the patient and his wife, who were quite pleased with the care and attention he had already received. We completed the consultation together, and as I left the room I suddenly felt a deep sense of satisfaction.

When the weight of illness suddenly descends on an individual, my colleague, and consequently, his patients, his co-workers and me, his partner, we can still take comfort in the small measures of success–the satisfaction that we, as a team, are doing things right. Sometimes it’s the little things, the small gestures and kindnesses that count. We dust ourselves off, and we go on.

About

In 2012, I realized that my thirty plus years of practice as a radiation oncologist had provided me with an abundance of stories–happy, sad, compelling and inspiring–and that these stories needed to be told. Along the way, stories from my “other life” as a mother of three, a daughter, an animal lover, and an occasional world traveler crept in. I hope you enjoy my stories as much as I enjoy telling them.